Abstract
Direct visualization of bile and pancreatic duct pathology is proving to be beneficial in patients where previous techniques have failed. Recent advancements in technology and the development of the SpyGlass system have led to an increased use of cholangioscopy. It is already known that SpyGlass is beneficial in patients with difficult bile duct stones and indeterminate biliary lesions through the use of targeted lithotripsy and visually guided biopsy. Cholangioscopy allows the visualization of hidden stone and guide wire placement across difficult strictures and selective cannulation of the intrahepatic and cystic ducts. It is also demonstrating its utility in investigational applications such as post-liver transplant and primary sclerosing cholangitis stricture treatment, evaluation of hemobilia, and guided radiofrequency ablation of ductal tumors. In addition to having clinical utility, cholangioscopy may also be cost-effective by limiting the number of repeat procedures. Cholangioscopy overall has similar complication rates compared to other standard endoscopic retrograde cholangioscopy (ERCP) techniques, but there may be higher rates of cholangitis. This could be mitigated with prophylactic antibiotic use, and overall, cholangioscopy has similar complication rates compared to other techniques.
Highlights
Endoscopic retrograde cholangioscopy (ERCP) is currently the tool of choice for diagnosis and intervention in pancreatobiliary disease
Another of area where cholangioscopy may be advantageous is in the diagnosis and treatment of hemobilia
Another area where cholangioscopy may be advantageous is in the diagnosis and treatment of may not be able to reveal the cause of the bleeding and the underlying pathology
Summary
Endoscopic retrograde cholangioscopy (ERCP) is currently the tool of choice for diagnosis and intervention in pancreatobiliary disease. While this technique is successful for many different scenarios, it remains limited by the fact that the endoscopist is only able to visualize structures indirectly via fluoroscopy. This indirect visualization can be especially limiting in patients with larger biliary stones and indeterminate biliary strictures [1]. There are currently three systems available for cholangioscopy including single operator, dual operator, and direct cholangioscopy. This review will focus on the recent advances in single operator cholangioscopy, which has allowed for easier use and wider utilization
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